CC BY-NC-ND 4.0 · Journal of Neuroanaesthesiology and Critical Care 2020; 7(03): 174-175
DOI: 10.1055/s-0040-1713558
Correspondence

Snippets on Disinfection of Anesthesia Equipment during COVID-19 Pandemic

Ranganatha Praveen
1  Department of Anesthesiology, Neuroanesthesia Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
,
Ajay P. Hrishi
1  Department of Anesthesiology, Neuroanesthesia Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
,
Unnikrishnan Prathapas
1  Department of Anesthesiology, Neuroanesthesia Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
,
Manikandan Sethuraman
1  Department of Anesthesiology, Neuroanesthesia Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
› Author Affiliations

In the backdrop of the ongoing COVID-19, there is an ever-increasing trend in the Western world toward the application of single-use or disposable equipment to prevent cross infection. However, for a country like ours, this may not be feasible due to economic burden on the institutions to procure a large inventory, higher costs for the patients, and the dilemma to deal with large loads of plastic waste management.[1] Thus, there is a need to continue the use of reusable equipment by sticking to strict decontamination practices. Anesthesia machines and equipment are potential vectors for transmission of the viral pathogen; hence, it should be disinfected after each case. Comprehensive knowledge of the disinfection agents and methods is imperative for the anesthesiologist to ensure the best infection control practice is followed so that the safety of the patients and health care workers is ensured, as elaborated in [Table 1].[2] [3] [4] [5] All equipment should be thoroughly disinfected after use in a suspected/confirmed COVID-19 patient.

Table 1

List of routinely used anesthesia equipment and the recommended disinfection protocol[1] [2] [3] [4] [5]

Anesthesia equipment

Method of disinfection

Abbreviations: AMBU, artificial manual breathing unit; BP, blood pressure; ECG, echocardiography; EtCo2, end-tidal carbon dioxide; EVD, external ventricular drain; FOB, fiberoptic bronchoscope; IV, intravenous; LMA, laryngeal mask airway; NIBP, noninvasive blood pressure; OT, operating theater; SPO2, peripheral pulse oximeter.

Video laryngoscope (blades)

  • Wipe with 70% isopropyl/ethyl alcohol within 1 minute of exposure

  • Followed by dipping in 1% sodium hypochlorite solution for 30 minutes

  • It is further disinfected as recommended by manufacturer (for example dipping in 2% glutaraldehyde solution for 20 to 30 minutes)

Screen-video laryngoscope/FOB

  • Cover with transparent polyethylene sheet

  • After use wipe with 70% isopropyl/ethyl alcohol

Fiber-optic bronchoscopes

  • Soak the endoscope in 0.23% peroxyacetic acid for 10 minutes

  • 0.23% peroxyacetic(peracetic acid) acid solution injected into the perfusion channel line with a 50-mL syringe until fully filled and wait for 10 min and again flushed for 5 minutes with 0.23% peroxyacetic acid solution

  • Followed by routine practice of disinfection

Laryngoscope blades

  • Wipe with 70% isopropyl/ethyl alcohol within 1 minute of exposure

  • Followed by dipping in 1% sodium hypochlorite solution for 30 minutes

  • Followed by routine practice of disinfection

Anesthesia induction masks/stylet/bougie

  • Single use disposable—disinfect and dispose

  • Dipping in 1% sodium hypochlorite solution for 30 minutes prior to disposal

Airways/LMA/Endotracheal tube

  • Single use disposable—disinfect and dispose

  • Dipping in 1% sodium hypochlorite solution for 30 minutes prior to disposal

Neuromonitoring electrodes

  • Dipping in 0.1–0.5% sodium hypochlorite solution for 30 minutes

  • Followed by routine practice of disinfection

Patient coming with lumbar drain system/EVD system to operating room

  • Wipe with 70% isopropyl/ethyl alcohol

Ultrasound/transcranial Doppler probes

  • Cover with transparent polyethylene sheet

  • After use, wipe with 70% isopropyl/ethyl alcohol

Anesthesia workstation

  • Cover with transparent polyethylene sheet

  • After use, wipe with 70% isopropyl/ethyl alcohol or 1% hypochlorite solution

ECG/SPO2/NIBP cables

  • After use wipe with 70% isopropyl/ethyl alcohol

BP cuff/thermometer/stethoscope

  • After use wipe with 70% isopropyl/ethyl alcohol

Anesthesia circuits + soda lime + viral filters

  • Disinfect and discard after each case

AMBU

  • Single patient use preferentially with viral filter

EtCO2 sampling line

  • Disinfect and discard after each case

Stretchers, backboards, OT tables and immobilization devices, IV stands, infusion pumps

  • 1% hypochlorite solution

Bolsters, pillows in operating room

  • Cover with transparent polyethylene sheet

  • After use wipe with 70% ethanol solution or 1% hypochlorite solution

Disinfection of disposables

  • Discard disposable items in a BioHazard bag

  • The interior is sprayed with 1% sodium hypochlorite

  • The bag is tied and exterior is also decontaminated with 1% sodium hypochlorite and should be given for disposal

Ensure a contact time of 10 minutes while using 1% sodium hypochlorite solution and the solution needs to be freshly prepared prior to each use for optimal results



Publication History

Publication Date:
07 June 2020 (online)

© 2020. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Juwarkar CS. Cleaning and sterilization of anaesthetic equipment. Indian J Anaesth 2013; 57 (05) 541-550
  • 2 Guideline for Disinfection and Sterilization in Healthcare Facilities. Available at: https://www.cdc.gov/infectioncontrol/guidelines/disinfection/index.html. Accessed May 26, 2020
  • 3 Coronavirus Disease 2019 (COVID-19): Standard Operating Procedure (SOP) for transporting a suspectirmed case of COVID-19. Available at: https://www.mohfw.gov.in/pdf/StandardOperatingProcedureSOPfortransportingasuspector-confirmedcaseofCOVID19.pdf. Accessed May 26, 2020
  • 4 Disinfecting Imaging Equipment During COVID19 Outbreak. Available at: https://www.diagnosticimaging.com/coronavirus/disinfecting-imaging-equipment-during-covid19-outbreak. Accessed May 26, 2020
  • 5 Liang L, Hongliu C, Yu C. Handbook of COVID 19 Prevention and Treatment. Zhejiang: Zhejiang University School of Medicine 2020